A variety of swallowed objects can become lodged in the stomach or intestines. Some foreign bodies cause obstruction or perforation. Diagnosis is made by imaging or endoscopy. Some foreign bodies can be removed endoscopically.
(See also Overview of Foreign Bodies in the Gastrointestinal Tract.)
Of the foreign bodies that reach the stomach, 80 to 90% pass spontaneously through the gastrointestinal (GI) tract, 10 to 20% require nonoperative intervention, and ≤ 1% require surgery. Thus, conservative management is appropriate for most blunt objects in asymptomatic patients. However, objects > 6 cm in length or objects > 2.5 cm in diameter rarely pass through the stomach (1).
Ingested drug packages (see Body Packing and Body Stuffing) are of great concern because of the risk of leakage and consequent drug overdose. Packages can also cause mechanical obstruction.
General reference
1. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, Anderson MA, et al: Management of ingested foreign bodies and food impactions. Gastrointest Endosc 73:1085–1091, 2011. doi: 10.1016/j.gie.2010.11.010
Symptoms and Signs of Gastric and Intestinal Foreign Bodies
Foreign bodies that pass through the esophagus are mostly asymptomatic unless perforation or obstruction occurs. Perforation of the stomach or intestines manifests with symptoms and signs of peritonitis such as abdominal pain, guarding, and rebound tenderness. Obstruction of the intestine causes abdominal pain, distention, and/or vomiting.
Diagnosis of Gastric and Intestinal Foreign Bodies
Imaging studies
Endoscopy
Abdominal x-rays may be done to identify the foreign object and are useful for following the progression of the object through the GI tract. Abdominal x-rays with chest x-rays are also important for identifying signs of perforation (eg, free air that is subdiaphragmatic, mediastinal, or subcutaneous). A portable metal detector can be helpful in localizing metallic foreign bodies, particularly in children. If plain x-rays are negative, a CT scan may be helpful.
Suspected body packers and stuffers are usually brought to medical attention by law enforcement officials. Plain x-rays can often confirm the presence of packets in the GI tract. If these x-rays are negative, a CT scan may be helpful.
DU CANE MEDICAL IMAGING LTD/SCIENCE PHOTO LIBRARY
Image provided by Alan Gingold, DO.
Image provided by Alan Gingold, DO.
Image provided by Uday Shankar, MD.
Image courtesy of Zubair Malik, MD.
Image courtesy of Zubair Malik, MD.
DU CANE MEDICAL IMAGING LTD/SCIENCE PHOTO LIBRARY
Image provided by Alan Gingold, DO.
Image provided by Alan Gingold, DO.
Image provided by Uday Shankar, MD.
Image courtesy of Zubair Malik, MD.
Image courtesy of Zubair Malik, MD.
Endoscopy allows detailed identification of a gastric foreign body.
Treatment of Gastric and Intestinal Foreign Bodies
Observation
Sometimes endoscopic removal
Rarely surgery
Management depends on several factors:
Location of the object
Nature of the object
Symptoms and signs
Gastric foreign bodies
Sharp objects should be retrieved from the stomach because of the risk of perforation. Small round objects (eg, coins) can simply be observed for a period of time that varies depending on the nature of the object. Patients should observe their stools for spontaneous passage of the object. If the object does not appear in the stool, x-rays should be taken at 48- to 72-hour intervals and then at weekly intervals. The following objects should be removed endoscopically (1):
Batteries that cause symptoms or signs of GI tract injury
Cylindrical batteries and disk batteries that remain in the stomach for > 48 hours without causing signs of GI injury
Sharp-pointed objects in the stomach
Objects > 2.5 cm diameter in the stomach
Any objects that remain in the stomach after 3 to 4 weeks
Any magnets within endoscopic reach
Intestinal foreign bodies
Most foreign objects that have passed into the small intestine usually traverse the GI tract without problem, even if they take weeks to do so. They tend to be held up around the curvature of the first part of the duodenum (duodenal sweep) and by the area of physiologic narrowing before the ileocecal valve. Sometimes objects such as toothpicks or fish bones remain within the GI tract for many years, only to turn up in a granuloma or abscess. Ingestion of a single magnet is unlikely to cause GI complications, but multiple magnets are extremely hazardous because they can become attracted to each other across loops of bowel, which can lead to fistula formation, obstruction, necrosis, or perforation.
Push enteroscopy or balloon-assisted enteroscopy can be used to access the small bowel and may have a role in the treatment of small-bowel foreign body ingestions in some patients.
Surgical removal should be considered for short, blunt objects that are located in the small bowel, distal to the duodenum, but have not changed location for more than 1 week and cannot be managed endoscopically and for patients presenting with bowel obstruction.
Drug packages
Patients who have ingested drug packages and who present with symptoms and signs of drug toxicity should receive medical treatment immediately. Prompt surgical evaluation should be obtained when sympathomimetic toxicity, bowel obstruction, perforation, or drug leakage is suspected. Asymptomatic patients should be admitted to the hospital and closely monitored in an intensive care setting.
Treatment reference
1. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, Anderson MA, et al: Management of ingested foreign bodies and food impactions. Gastrointest Endosc 73:1085–1091, 2011. doi: 10.1016/j.gie.2010.11.010
Key Points
Foreign bodies that pass through the esophagus are asymptomatic unless perforation, obstruction, or drug leakage from ingested packets occurs.
Imaging studies may identify the foreign object and are useful for following the progression through the gastrointestinal (GI) tract.
Management depends on the nature of the object, but sharp objects should be retrieved from the GI tract.
Impacted drug packages can cause serious or fatal toxicity; even asymptomatic patients require close monitoring.
Endoscopic removal of drug packages is not recommended because of the high risk of package rupture.
